Provider Demographics
NPI:1093361305
Name:EVOLUTION COUNSELING AND YOGA LLC
Entity Type:Organization
Organization Name:EVOLUTION COUNSELING AND YOGA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:FARLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:419-575-1978
Mailing Address - Street 1:799 N COURT ST STE 11
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-1766
Mailing Address - Country:US
Mailing Address - Phone:419-575-1978
Mailing Address - Fax:419-710-6334
Practice Address - Street 1:799 N COURT ST STE 11
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-1766
Practice Address - Country:US
Practice Address - Phone:419-575-1978
Practice Address - Fax:419-710-6334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-13
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty